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[Evaluation of practices in surgical antimicrobial prophylaxis in the Franche-Comté before and after implementation
1Réseau franc-comtois de lutte contre les infections nosocomiales, CHU Jean Minjoz, 25030 Besançon, France.
Objectives:
To assess the practices of surgical antimicrobial prophylaxis in the Franche-Comté region of France before and after the implementation of information program.
Study Design:
Prospective multicenter transversal study type before/after. The information program included a feedback on the observed results during the period before and a meeting with opinion leaders.
Patients And Methods:
Data were collected by 28 pairs of surgeons/anaesthetists. Prescriptions were analysed to answer five questions about antibiotic prophylaxis practices in surgery: did the surgical procedure require antibiotic prophylaxis and was this carried out? Was the appropriate antibiotic used? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct? Our data were compared to national recommendations (updated in 1999).
Results:
The overall frequency of conformity was about 40% both before and after the implementation of an information/awareness campaign. Only the conformity of the total duration of the prophylaxis was significantly higher after the action, but only for interventions that lasted less than two hours. [RR = 2.09 (1.32-3.31), p = 0.001]. This improvement in the total duration of regulation seemed to be related to the more frequent use of written protocols in the surgical units.
Conclusion:
Our study confirms that information campaign have little effect within the framework of the good use of antibiotics. We agree with the experts who claim that only an overall strategy including organization, education and restriction will really improve the frequency of conformity of the practices of surgical prophylaxis.